Pet Pantry Program Application

This form helps us learn about you and your pets so we can offer the best support possible.
All of your answers are private and kept confidential.

Free Pet Food & Supplies
Available to families in Utah. All items are donated and depend on what we have. They are meant to help support your pet, not replace all regular pet food. Assistance is per household.

No Proof of Income Needed
If you say you need help, we believe you.
No financial paperwork is required.

Length of Assistance
You can receive pantry support for up to 6 months. After a check-in, support may be extended up to 12 months total. Any help beyond that is decided case by case.

Spay/Neuter Requirement
Pets must be spayed or neutered within 6–12 months of starting the program. We may be able to help with the cost.

ID Required
Some form of ID is needed. It does not have to be government-issued. This can be a photo ID, a piece of mail with your name and address, or a note from a caseworker.

No New Pets
New pets cannot be added during the first 6 months unless there is a change in your situation and it is approved.

Picking Up for Someone Else
If you are picking up for another person, their information must be on file.

Phone Intake Required
A short 5–10 minute phone call is mandatory. If you need a different option, let us know- we’re happy to help.
Email Address
example@example.com
(MAY)

Thursday, May 21st, 6 pm to 7 pm

Saturday, May 23rd, 12 pm to 1 pm

Tuesday, May 26th, 8 am to 9 am

Thursday, May 28th, 6 pm to 7 pm

Saturday, May 30th- CANCELLED

(JUNE)

Tuesday, June 2nd, 8 am to 9 am

Thursday, June 4th, 6 pm to 7 pm

Saturday, June 6th, 12 pm to 1 pm

Tuesday, June 9th, 8 am to 9 am

You may pick up food once per month.

No appointment is needed.

You must complete the application and intake phone call before coming to pick up food.

If you arrive without completing an intake, we will not be able to provide food.

Pick-up dates change each month.

It is your responsibility to check the schedule.

Dates will not be emailed or sent out monthly.
Applicant Information
Phone Number
Format: (000) 000-0000.
Address-- or provide a zip code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please enter the number of pets you have by size:

(Note: Ruff Haven can provide food for up to 5 pets per household)
Small Dogs (e.g., under 20 lbs):
Medium Dogs (e.g., 20-50lbs)
Large Dogs (e.g., 50-80 lbs):
Extra Large Dogs (e.g., over 80 lbs):
Cats (up to 5):
Litter is not always available but we do try to provide it when it is; is this something you will need?
Do you have any special requests for your pet(s) (e.g., dietary restrictions, allergies, etc.)? If yes, please list concerns.Please note: while we will do our best to consider these needs, specific items or accommodations cannot be guaranteed due to the nature of donated supplies.
Are you home-bound and require delivery? If yes, please note that delivery is available only within specific ZIP codes and for individuals unable to leave their home due to medical or health reasons with proof of being home-bound.
Please confirm that you reside in one of the listed ZIP codes if you are requesting delivery.
Appointment Scheduling & Walk-in Information

Below is a scheduler to make an appointment for a mandatory phone call to do a 5-10 minute intake call.

If you need accommodations or an alternative option, please let us know and we will do our best to help.
Intake Call (Select ONE Appointment)
Please read and mark all boxes to indicate you understand the following:
Who will be picking this food up? If other, please provide the name and phone number or email of the person picking up for you:

Other
What is the other applicant's name?

First NameLast Name
Support/Needs Section

We ask these questions to help you and your pet in the best way we can. Your answers also help us improve our program and show funders how our services make a difference.

We will never share or sell your personal information without your permission, unless the law requires it. Your information is stored safely and kept private.

When we share information for reports, we remove your name and any personal details so no one knows it’s you.

By filling out this form, you agree that we can use your answers to help you and make our services better.
Primary Language Spoken at Home
Race/Ethnicity
Pronouns Used (she/her, he/him, they, etc.)
Are you a military veteran or currently serving in the military?
Do you identify as person living with a disability?
What is your current housing situation?
Are you currently receiving government assistance? (e.g., SNAP, TANF, Medicaid)
Number of pets in your household:
How many of your pets are spayed or neutered (fixed)?
Do any of your pets have medical conditions or special needs?
If yes please describe
Which of the following services or items would help you care for your pet(s)? (Check all that apply)
Would you like a staff member to contact you about additional services or referrals for your pet(s)?
Would you like help connecting with any of the following community resources?
Would you like a referral to local agencies or organizations that support families in crisis?
Have you or anyone in your household been impacted by opioid use (including prescription or non-prescription opioids)?
If yes, would you like help connecting with support services related to substance use recovery
If you are facing other challenges or need further assistance please describe below:
Signature
Date

MonthDayYear
Date
For questions or additional information, please contact:

Email: petpantry@ruffhaven.org
Text: 801-613-2198

NEW ADDRESS: 264 S. Glendale St. (1135 W.), Salt Lake City, UT 84104
(General Tip: We’re just off 1100 West and 300 South in a warehouse-style building on the Jordan Parkway trail across from Franklin Elementary School.)
Please verify that you are human
Name as listed on the verifiable document you plan to use at check in

First NameLast Name
Type a question
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Applicant Information

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